上消化道出血县级医院版临床路径的运用

Application of county hospital version clinical pathway in upper gastrointestinal bleeding

目的探讨上消化道出血(UGIB)县级医院版临床路径(CP)的运用价值。方法选取2016年7月至2018年7月廉江市人民医院消化内科收治的120例UGIB患者作为研究对象。采用随机数字表法将其分为观察组和对照组,每组各60例。对照组采用常规治疗,观察组采用UGIB县级医院版CP治疗。统计比较两组的疗效、卧床时间、禁食时间、入院第3天大便潜血阴性率、主要住院费用、住院时间、满意度和出院后医嘱执行情况。结果观察组的疗效明显好于对照组(U=2.216,P=0034)。观察组的卧床时间、禁食时间、住院时间均明显短于对照组(P均<0.01)。观察组大便潜血阴性率为91.67%,明显高于对照组的78.33%(P<0.05)。观察组的检查费、药费、其他费和总住院费用均明显低于对照组(P均<0.01)。观察组患者和患者家属满意度均明显高于对照组(P<0.05)。观察组按时按量服药、合理作息和复诊的发生率均高于对照组(P均<0.05)。结论UGIB县级医院版CP可提高疗效,缩短患者的卧床时间、禁食时间和住院时间,同时可降低住院费用,提高患者和患者家属满意度及出院后医嘱的执行度。

Objective To investigate the application value of county hospital version clinical pathway ( CP) in upper gastrointestinal bleeding ( UGIB). Methods A total of 120 UGIB patients who received treatment from July 2016 to July 2018 in Lianjiang People's Hospital were selected and divided into observation group and control group randomly (n = 60, each). The control group patients received regular treatment, and observation group patients received UGIB county hospital version CP treatment. The curative effect, bedridden time, fasting time, negative constituent ratio of fecal occult blood on the third day of admission, main hospitalization expense, hospitalization time, satisfaction and implementation of medical orders after discharge were compared between the two groups. Results The curative effect in observation group was significantly better than that in control group ( U = 2. 216, P = 0. 034). The bedridden time, fasting time and hospitalization time in observation group were significantly shorter than those in control group ( all P < 0. 01 ). The negative rate of fecal occult blood in control group was significantly higher than that in observation group ( 91. 67% vs 78. 33%, P < 0. 05 ). The examination expense, medicine expense, other expense and total hospitalization expense of observation group were significantly lower than those of the control group ( all P < 0. 01). The satisfaction of patients and their families in the observation group was significantly higher than that in the control group (P < 0. 05 ). The incidence of taking medicine on time and in quantity, reasonable work and rest, and re-examination in the observation group was higher than that in the control group ( all P < 0. 05). Conclusion UGIB county hospital version CP could improve the curative effect, shorten the bedridden time, fasting time and hospitalization time of patients, reduce hospitalization costs, improve patient satisfaction, family satisfaction and the implementation of doctor's advice after discharge.